Another kind of consultation: pro bono community health consultation for medical students

Since 2015, groups of medical students at Northwestern Feinberg School of Medicine in Chicago have been working to answer the question: How can we improve health care at a systems level?

Medical students have been and will always be expected to provide personalized, high-quality care to their patients. But across all the learning, rotations, research, and clinical volunteering, there is another area of ??professional growth and health care activity emerging that enables students to contribute to broader change across the health care system: community health counseling.

Feinberg’s group of students, more than 50 in any given year, are members of Second Opinions, a 501(c)(3) nonprofit student organization founded by three management consultant-turned-physicians. Second Opinions aims to promote system-level change in healthcare by pairing medical students with local healthcare organizations to support a variety of administrative and strategic initiatives.

Groups of 4 to 5 Second Opinions members work on discrete projects for four months at a time, addressing issues ranging from clinical workflow analysis to health care and nonprofit economics. Current projects include helping a local community clinic improve its mammography referral network and assisting a second clinic in creating a fair sliding payment system for uninsured patients. While our projects are based on established timelines, we have established follow-up procedures in which we continue to work with clients to resolve emerging issues. This continuum of care approach is critical at every level of healthcare and is what draws many of us into medicine in the first place.

Second Opinions works best at improving outcomes for underserved populations. Amid rising health care costs and fluctuating legislation, Free and Charity Clinics (FCCs) and Federally Qualified Health Centers (FQHCs) are leading the way in bringing accessible care to underinsured or uninsured Americans. To help them overcome their greatest barriers, quantify community impact, and access funding, our group recently created a reimbursement assessment tool to determine the monetary and quality-adjusted life-year (QALY) value of services provided by free clinics and the appropriate value for emergency avoidance Department visit.

Our valuation tool started to make an impact locally, but quickly gained traction nationally. First, we introduced a cluster of more than 40 FCCs to the Illinois Free and Charitable Clinic Association. In no time, our team introduced the association to the board members of the National Association of Free and Charitable Clinics, which consists of more than 1,400 FCCs. This information has important implications for how healthcare resources are allocated, and our work to quantify avoided downstream costs and disease reinforces the case for investing in these providers.

Changes at the system level do not have to happen nationally. This work could start by helping local women’s health clinics transition from paper records to an efficient electronic health record system so they can see more underrepresented Chicagoans every day. It can perform community health needs assessments for neighboring clinics operating west and south of Chicago and even help our own facility expand the reach of its pediatric mobile health program.

Through experiences like this, our medical student members learn how to have an impact on system-level health care issues and have the power to help individual patients and systems—with the ability to care for forests and trees. The issues we face are complex and open-ended, and the challenge for our members is to find ways to measure system performance and implement changes through policies, workflow improvements, and clinical protocols that benefit the entire patient population, and services in particular underserved groups. It’s a tall order, but our strength as medical students is that we always look closely from the inside with fresh perspectives and a passion for creative innovation.

Our members grew up in an era marked by disparities and inefficiencies in healthcare. The dysfunctions of our American healthcare system are broadcast to us throughout the medical school. We are ready to innovate, and we believe that physicians should always have a place in improving healthcare systems and running healthcare businesses. Our members are eager to provide actionable advice and find solutions to the problems that burden underrepresented patients we want to care for in clinics and hospitals throughout their careers. We also realize that we have a lot to learn. Our members remain humble enough to start each project by listening as long as they fully understand the scope of the issue at hand. Most importantly, our members are creative – daring to invent solutions without precedent to guide them.

We encourage medical interns across the country to join our efforts to advance community health through strategic work. Anyone working on community health has room to help, and we’re excited to support others through this important work. System-level changes are difficult but powerful, so help and be creative where you need it. If you need a second opinion, you know who to turn to.

PhD. Cecil Qiu, Liz Nguyen, and Benjamin Peipert contributed to this article. Both graduated from Northwestern University Feinberg School of Medicine. Qiu is a resident physician at Johns Hopkins University School of Medicine, Nguyen is a resident physician at Stanford University School of Medicine, and Peipert is a resident physician at Duke University School of Medicine.

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